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Andrea Peracino, Alberto Lombardi 13 Ottobre 2012 BOLOGNA - STABAT MATER ARCHIGINNASIO

Does a gender medicine approach contribute to reduce inequalities and costs in the management of chronic non communicable diseases?. Andrea Peracino, Alberto Lombardi 13 Ottobre 2012 BOLOGNA - STABAT MATER ARCHIGINNASIO www.gendermedicine.org.

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Andrea Peracino, Alberto Lombardi 13 Ottobre 2012 BOLOGNA - STABAT MATER ARCHIGINNASIO

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  1. Does a gender medicine approach contribute to reduce inequalities and costs in the management of chronic non communicable diseases? Andrea Peracino, Alberto Lombardi 13 Ottobre 2012 BOLOGNA - STABAT MATER ARCHIGINNASIO www.gendermedicine.org

  2. How much high is the economic burden on NHSs derived from a limited knowledge on and a non appropriate medical approach to, gender inequalities?

  3. Quality of Life Index www.economist.com 2005 2010 cost of living culture and leisure economy environment freedom health infrastructure safety and risk climate • material well being • health • family relations • job security • social and community activities • political freedom and security • gender equality

  4. Figure 1 Life expectancy in countries in the WHO European region, 2010 (or latest available data)Data from WHO health for all database Source:The Lancet 2012; 380: 1011-1029 (DOI:10.1016/S0140-6736(12)61228-8) Terms and Conditions

  5. Figure 1 Life expectancy (LE) and healthy life years (HLYs) at 50 years of age (all EU countries) Source The Lancet 2008; 372: 2124-2131

  6. Deaths for Men in Europe Deaths for Women in Europe EHN-ESC European Cardiovascular Disease Statistics 2012

  7. Deaths < 65 for Men in Europe Deaths < 65 for Women in Europe EHN-ESC European Cardiovascular Disease Statistics 2012

  8. Disability-adjusted life years lost by cause, 2002, Europe in men in women EHN-ESC European Cardiovascular Disease Statistics 2012

  9. Figure 9 Female unemployment rates in selected European countries by age, 2011 Data from the Labour Force Survey The Lancet 2012; 380: 1011-1029 (DOI:10.1016/S0140-6736(12)61228-8) Terms and Conditions

  10. Figure 10 differences between women and men in healthy life years, years not in good health and life expectancy at birth in selected European countries Data from the Eurostat database. 2008 data for Italy and UK. The Lancet 2012; 380: 1011-1029 (DOI:10.1016/S0140-6736(12)61228-8) Terms and Conditions

  11. prevalence of smoking, boys aged 15 years, 2009/10, EuropeEHN-ESC European Cardiovascular Disease Statistics 2012

  12. prevalence of smoking, girls aged 15 years, 2009/10, EuropeEHN-ESC European Cardiovascular Disease Statistics 2012

  13. change in smoking rates among 15 year olds, by sex, 1993/94 to 2009/10, EuropeEHN-ESC European Cardiovascular Disease Statistics 2012

  14. proportion of 11 year olds participating in 1 hour or more of MVPA per day, by sex, 2009 EHN-ESC European Cardiovascular Disease Statistics 2012

  15. proportion of 13 year olds participating in 1 hour or more of MVPA per day, by sex, 2009EHN-ESC European Cardiovascular Disease Statistics 2012

  16. proportion of 15 year olds participating in 1 hour or more of MVPA per day, by sex, 2009EHN-ESC European Cardiovascular Disease Statistics 2012

  17. proportion of 11 year olds watching 2 or more hours of television per day, by sex, 2009, EuropeEHN-ESC European Cardiovascular Disease Statistics 2012

  18. proportion of 13 year olds watching 2 or more hours of television per day, by sex, 2009, EuropeEHN-ESC European Cardiovascular Disease Statistics 2012

  19. proportion of 15 year olds watching 2 or more hours of television per day, by sex, 2009, Europe EHN-ESC European Cardiovascular Disease Statistics 2012

  20. percentage of total healthcare expenditure on CVD in the EU, 2009, by resource use categoryEHN-ESC European Cardiovascular Disease Statistics 2012

  21. total cost of CVD, CHD and Cerebrovascular diseases, 2009, EU EHN-ESC European Cardiovascular Disease Statistics 2012

  22. direct health care costs in some country cost of CVD, CHD and Cerebrovascular diseases, 2009EHN-ESC European Cardiovascular Disease Statistics 2012

  23. indirect health care costs in some country cost of CVD, CHD and Cerebrovascular diseases, 2009, € mio (* estimated)EHN-ESC European Cardiovascular Disease Statistics 2012

  24. cost/benefitratio in prevention Cardiovascular model: popultion attribuable risk -PAR diet and physical activityPAR =32,8% apo B/apo AI ratioPAR = 12,5% weigh/hip ratio PAR 5,0% blood pressure PAR =1,8% global PAR = 52,1%

  25. cost/benefit ratio in prevention Cardiovascular model: primary and secundary prevention In the last ten years it has been observed (*) : An increase of percentage of physycal activity in women (from29,5 to 30,8%)and a decreasein men (from33,5 to 32,9%). An increase of statin use in men 45-54 year old (from2,5% to 16,8%)and in women after 65year old (from 1,9%a 13,5%).The increase after 65° year of life in men went from1,9%to 38,9 % and from 3,5%to 32,8%in women. The statin use in both gender between 45 and 60 year of life is under the primary prevention reccomandation (NEJM 2010; 362: 2150-1). (*) Centers for Disease Control and Prevention- CDC (NEJM 2010; 362: 2155-65)

  26. cost/benefit ratio in prevention HPV vaccination model The cost in Italy of HPV related disease is estimated to be between € 200 and € 250 million per year, of which € 210 million are absorbed by the screening and treatment of precancerous lesions and cancer of the cervix (Francesco Mennini: Vaccine 2009; 27: A54-A61). Using the Markov’s model it has been possible to estimate the threshold of affordability for vaccination which is 9,569 and 26,361 per Quality Adjusted Life Year - QALY gained respectively by the use of bivalent or quadrivalent vaccine The value for the quadrivalent vaccine (which is also valid for genital warts) allows a reduction of expenditure to 68.6%(€140-170 miliardi) In terms of lives is calculated a reduction of 63,3%, 1.432 new cases of cervical cancer and 513 deaths, compared to using only screening (Francesco Mennini :Gynecologic Oncology 2009; 112:370.76)

  27. cost/benefit ratio in prevention Are gender bias in the National Health Systems approach to women MI? Are the two days more in Intensive Care Units stay of women modifying the cost/return ratio from DRG? Are the stents use in women (NEJM 2007; 356: 898-1009 e Circulation 2007; 115: 833-39) raising questions on women specific protocols?

  28. cost/benefit ratio in prevention Pharmaceutical research The alarm raised in 2000 (NEJM 2000; 343: 475-80) and 2001 (JAMA 2001; 286: 708-13), on the minor presence of women in the development and risk/effectiveness trials of many drugs is still unsatisfied.

  29. cost/benefit ratio in prevention Pharmaceutical research After years the representation of women is fairly over the 30% of enrolled subjects. In American Heart Association studies it is shown that sex-specific results were discussed in only 31% of primary trial publications. Women accounted for 53% of all individuals with hypertension, 50% with diabetes, 51% with heart failure, 49% with hyperlipidemia and 46% with coronary artery disease. By contrast the representation of women in the analyzed trials is higher than the average among trials in hypertension (44%), diabetes (40%) and stroke (38%) and lowest for heart failure (29%), coronary artery disease (25%) and hyperlipidemia (28%). Enrollment of women in randomized clinical trials has increased over time but remains low relative to their overall representation in disease populations. Efforts are needed to reach a level of representation that is adequate to ensure evidence-based gender-specific recommendations. Circ Cardiovasc Qual Outcomes. 2010; 3: 135-42.

  30. gender challenge Years ago a “gender challenge” has been launched by WHO to nations and international organizations. The call was for: a better appreciation of risk factors involving women’s health; the development of preventive strategies to lessen the impact of diseases that disproportionately plague older women (e.g., coronary heart disease, osteoporosis and dementia); an increased emphasis on understanding why men die sooner than women (World Health Organization, 1998, The World Health Report 1998, Geneva).

  31. the burden of NCD and BD With the claim “Stop the global epidemic non communicable disease“the WHO was launching its strategic “2008-2013 Action Plan for the Global Strategy for the Prevention and Control of non-communicable Diseases” drawn up by the Secretariat as requested by the Health Assembly in resolution WHA60.23. The aim was to work in partnership to prevent and control the 4 non-communicable diseases - cardiovascular diseases, diabetes, cancers and chronic respiratory diseasesand the 4 shared risk factors - tobacco use, physical inactivity, unhealthy diets and the harmful use of alcohol.Unfortunately WHO is missing the fifth common risk: the indoor and outdoor pollution! The increase of urbanization channels the five risk factors in an even more explosive melting pot of injury to the human health.

  32. the burden of NCD and BD Major chronic non-communicable diseases (NCDs) - primarily cardiovascular disease (CVD), cancer, chronic obstructive pulmonary disease (COPD) and diabetes - are responsible for 85% of the deaths and 70% of the burden of disease in Europe. Atherosclerosis Supplements 2009; 10: 1-30 The Disorders of the Brain -BD in Europe are responsible for around 15,8 million DALYs (26,6% of global DALYs) in the population aged > 15 age: 7,3 million for men (23,4%),8,5 million for women (30,1%). H.U. Witchen, F. Jacobi et alii European Neuropsychopharmacology 2011; 21: 655–679.

  33. size and burden of Mental Disorders and other Disorders of the Brain in Europe 2010 (H.U. Witchen, F. Jacobi et alii European Neuropsychopharmacology 2011; 21: 655–679)

  34. the burden of NCD and BD The economic burden (direct and indirect costs) of BDsin Europe of € 798 billion/yearexceeds the € 200 billionspent to manage cardiovascular diseaseand the 150 billion spent on cancer management (Eur Neuropsychopharmacology 2011; 21 (10): 718-79)

  35. the burden of NCD and BD While the effect of gender, age and cultural behavior on the health both of women and men has been widely studied, attention to the impact of the gender differences on the patho-physiology and, therefore, on the management of the most common social diseases such as the group of chronic Non Communicable Diseases (NCD) (e.g. cardiovascular disease, diabetes, obesity, chronic obstructive pulmonary diseases and some tumors) and the group of Brain Disorders (BD)(e.g. dementias, depression, anxiety and mood disorders, to list a few) is both needed and lacking

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